Anorexia nerviosa: La eficacia de la terapia de conducta

RESUMEN

Dos artículos criticados sobre el tratamiento conductual de la anorexia nerviosa publicados por la Dra. Bruch (1976), en los que afirma que el peso ganado por ese procedimiento se pierde rápidamente y que esta ganancia de peso no se acompaña de otros cambios positivos, se compara con la revisión de varios artículos en los que se utilizó la terapia de conducta en este trastorno. Las críticas de Bruch no son apoyadas por los datos. Se observa la existencia de pruebas empíricas que apoyan la idea de que la terapia de conducta es el tratamiento de elección en la anorexia. A pesar de los grandes conocimientos de la autora en el área de los trastornos de comida y sus numerosas publicaciones, su crítica es muy pobre, especialmente en los que se refiere a datos controlados. En este estudio se intenta probar los supuestos planteados por la Dra. Bruch comparando sus críticas con los tratamientos conductuales de anorexia que se han publicado.     

Programa de Autocontrol de la obesidad: Datos de un año se seguimiento

Resumen

El objetivo de este trabajo fue el diseño y aplicación de un programa de tratamiento de la obesidad que lograra que los sujetos no sólo perdieran peso, sino que lo mantuvieran estable al menos un año después. El programa se aplicó a dos grupos de 10 sujetos durante 11 sesiones semanales. El peso de los 16 sujetos que terminaron el programa se redujo en una media de 5,9 kilogramos, el perímetro de la cintura, en 5,8 centímetros, y el grosor del pellizco de grasa, en 14,3 milímetros. El programa mostró que no inducía depresión en los sujetos, sino que por el contrario ésta se redujo. Se analizan los datos de seguimiento al mes, a los seis meses y al año.     

Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy

The family therapy field encourages commitment to diversity and social justice, but offers varying ideas about how to attentively consider these issues. Critical informed models advocate activism, whereas postmodern informed models encourage multiple perspectives. It is often not clear how activism and an emphasis on multiple perspectives connect, engendering the sense that critical and postmodern practices may be disparate. To understand how therapists negotiate these perspectives in practice, this qualitative grounded theory analysis drew on interviews with 11 therapists, each known for their work from both critical and postmodern perspectives. We found that these therapists generally engage in a set of shared constructionist practices while also demonstrating two distinct forms of activism: activism through countering and activism through collaborating. Ultimately, decisions made about how to navigate critical and postmodern influences were connected to how therapists viewed ethics and the ways they were comfortable using their therapeutic power. The findings illustrate practice strategies through which therapists apply each approach.     

Couples Relationship Education and Couples Therapy: Healthy Marriage or Strange Bedfellows?

This paper focuses on issues sparked by the Couples Relationship Education (CRE) field moving toward a more clinical model to meet the needs of an increasing number of distressed couples coming to CRE programs. We review the concerns raised and recommendations made by Bradford, Hawkins, and Acker (2015), most of which push CRE toward a more clinical model. We address these recommendations and make suggestions for best practices that preserve the prevention/education model underlying research‐based CRE. The three main issues are couple screening, leader training, and service delivery models. Our suggested best practices include: conducting minimal screening including the assessment of dangerous levels of couple violence, training leaders with key skills to handle issues raised by distressed couples as well as other couples who may place additional burdens on leaders, providing referrals and choices of programs available to participants at intake and throughout the CRE program, and adding (rather than integrating) clinical services to CRE services for couples who desire additional intervention. Finally, throughout the paper, we review other key issues in the CRE field and make recommendations made for future research and practice.     

Addressing Culture,Gender, and Power with Asian American Couples: Application of Socio‐Emotional Relationship Therapy

Asian Americans juggle the intersections of multiple social identities and societal discourses as they respond to experiences of immigration, marginalization, and patriarchy, integrate collectivist and individualistic family values, and form families and intimate relationships. In this study we examine what we have learned as we apply Socio‐Emotional Relationship Therapy (SERT) with heterosexual couples of Asian heritage. SERT begins with sociocultural attunement and the assumption that relationships should mutually support each partner. Drawing on case examples, we illustrate how we practice sociocultural attunement as couples respond to the relational processes that comprise the Circle of Care (mutual influence, vulnerability, attunement, and shared relational responsibility). We emphasize three key socioemotional themes that intersect with gender: (1) intangible loss; (2) quiet fortitude/not burdening others; and (3) duty to the family.     

A Randomized Controlled Trial of Coach Contact During a Brief Online Intervention for Distressed Couples

The negative impacts of relationship distress on the couple, the family, and the individual are well‐known. However, couples are often unable to access effective treatments to combat these effects—including many couples who might be at highest risk for relationship distress. Online self‐help interventions decrease the barriers to treatment and provide couples with high quality, research‐based programs they can do on their own. Using a combined multiple baseline and randomized design, the present study investigated the effectiveness of the Brief OurRelationship.com (Brief‐OR) program with and without staff support in improving relationship distress and individual functioning. Results indicated the program produced significant gains in several areas of relationship functioning; however, these gains were smaller in magnitude than those observed in Full‐OR. Furthermore, effects of Brief‐OR were not sustained over follow‐up. Comparisons between couples randomized to Brief‐OR with and without contact with a staff coach indicated that coach contact significantly reduced program noncompletion and improved program effects. Limitations and future directions are discussed.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

Déjà vu现象理论及其相关实验研究述评

Déjà vu指任何对目前体验的一种不适宜的熟悉感,并伴随着对过去体验的不确定感。对déjà vu的进一步深入研究将澄清对记忆的认识。首先,文章阐述了déjà vu现象产生的理论解释;其次,将相关的实验研究概括为：阈下知觉实验研究和阈上知觉实验研究。最后,讨论了目前déjà vu研究中所存在的一些问题。     

Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

Between pink and blue: a multi-dimensional family approach to gender nonconforming children and their families

Families of gender nonconforming children need to negotiate the interactions between two gender systems: a rigid gender binary imported from familial, social, and cultural experiences and a fluid gender spectrum articulated by their child. This article reviews parental reactions to nonconforming gender developments and poses that the parental mandates of protection and acceptance are problematized by the difference of gender norms between the child and the family, as well as the child and the environment. Through multiple therapeutic modalities-parental coaching and education, parent support group, and child and family therapy-the author illustrates interventions supporting both parents and prepubescent children in their negotiation of safety, connection, and fluidity. Case vignettes illustrate the method in action.